AB1456 CLINICAL IMPACT OF THE INTERSTITIAL LUNG DISEASE MULTIDISCIPLINARY SERVICE
Authors: S. Eisa, B. Osei-Boadu, G. Singh-Rathore, M. Rabbani, K. Suthar, S. Ansari, G. M. Koduri
Journal: Annals of the Rheumatic Diseases (2022)

Background Interstitial lung diseases (ILD) are a diverse group of pulmonary diseases for which accurate diagnosis is critical for optimal management and outcomes. Diagnosing ILD, both idiopathic pulmonary fibrosis (IPF) and connective-tissue-disease-associated interstitial lung disease (CTD-ILD), has become critically important, as the disease has a devastating prognosis with poor survival.There are also management implications, as patients with ILD can now potentially be treated with new antifibrotic therapies such as pirfenidone and nintedanib, both of which have been approved. Certain types of CTD – ILD may benefit from systemic immunomodulatory therapies. Diagnosis of ILD can be challenging and a multidisciplinary team (MDT) approach is recommended in current guidelines. Several studies have reported that MDT diagnosis is associated with higher levels of diagnostic confidence and better interobserver agreement (1-3). Objectives We describe the benefits of an ILD multidisciplinary service on the diagnosis and management of patients with suspected ILD. Methods We performed a single-centre retrospective review of consecutive patients referred to the ILD clinic with subsequent discussions in ILD MDTs over a 36-month period from 2016 to 2019. We compared changes in ILD diagnosis and management at referral to those following the ILD-MDT. We collected data on the demographics, occupation, age at ILD onset, smoking status, imaging, blood tests including autoimmune serology, MDT recommendations, change in diagnosis after MDT, tertiary referral, serial PFTs, medications and outcomes. Cases of suspected ILD that were not fully characterised and those with complex management issues were presented at our monthly ILD MDT. Results A total of 208 patients were referred to the ILD clinic over a 36-month period. Of these, 106 cases were discussed at the ILD MDT and the remaining 102 cases did not require discussion at the MDT as these deemed to be clear cut, which included RA and CTD ILD. The mean age of the total cohort was 74 (min age 32, max age 97) and 120 (58 %) were males. Overall, evaluation by the ILD service (i.e. ILD clinic and MDT) resulted in a change in diagnosis in 106(51%) patients. Of those, 49(46%) didn’t have ILD. In the remaining 57 patients with suspected ILD, the majority of the diagnoses were ILD with an uncertain classification (24, 23%). The other diagnoses included CTD-ILD (4, 3.7%), ILD with autoimmune serology 11(10.4%), IPF 10(9.4%), Drug-induced-ILD 3(2.8%), Hypersensitivity Pneumonitis 5(4.7%), Eosinophilic pneumonitis 1 (0.94%), Cryptogenic Pneumonitis 1(0.94%), PPFE with IPF 1 (0.94%), PPFE 1 (0.94%), CPFE 4 (0.94%), EAA 2 (0.94%), RB-ILD 2 (1.88%), Langerhans Histiocytosis 2 (1.88%).16/57(28%) were referred to a tertiary centre for further management. Serology was positive in 11 patients (ANA 6, CCP 3, and ANCA 2). Of the 57 patients with other diagnoses, the main recommendations included steroids (28), anti-fibrotic therapy (4), immunomodulatory therapy (6) and ambulatory Oxygen (1). Further analysis will be carried out on survival and treatment outcomes of the cohort. Conclusion Dedicated ILD-MDT service has an important clinical impact on the care of the ILD patient, with frequent changes in ILD diagnosis and subsequent management and outcomes. Multidisciplinary approach to the management of these patients should be standard of care for these patients. References [1]Flaherty KR, King TE Jr, Raghu G, et al. Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? Am J Respir Crit Care Med 2004; 170:904-10. [2]Lynch DA, Sverzellati N, Travis WD, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med 2018; 6:138-53. [3]Ryerson CJ, Corte TJ, Lee JS, et al. A standardized diagnostic ontology for fibrotic interstitial lung disease. An international working group perspective. Am J Respir Crit Care Med 2017; 196:1249-54. Disclosure of Interests None declared